Much work to be done: Donor funding remains integral to health

For many countries, development assistance for health is just a small portion of their total health budget. In 2012, low- and middle-income countries spent twice as much money on health than donors spent to improve health in these countries according to a new report published by the Institute for Health Metrics and Evaluation (IHME), Financing Global Health 2014: Shifts in Funding as the MDG Era Closes. However, for some countries, most of whom are sub-Saharan African countries, development assistance for health represents a large portion of their total health spending, making them extremely vulnerable to shifts in donor funding. Alongside countries’ own health spending, donor funding has played an important role in boosting life expectancy in these countries.

The below screen grab shows countries where 50% or more of the total health budget came from international donors in 2012. Most of these countries are in Eastern and Central Africa, but Afghanistan, Cambodia, Haiti, Myanmar, and Timor-Leste also fall into this category.

Ratio of development assistance for health to government health expenditure, 2012

The money that donors and country governments themselves are investing in health has paid off. Many of these countries have succeeded in increasing their life expectancy dramatically since 1990. For example, the image below shows how life expectancy changed between 1990 and 2013 in the sub-Saharan African countries highlighted in the previous map. Ethiopia and Rwanda had the most dramatic changes in life expectancy among these 13 countries. In Ethiopia, life expectancy increased from 47 years in 1990 to 63 years in 2013. In Rwanda, life expectancy jumped from 49 in 1990 to 66 years in 2013.

Notes: The causes adding years of life expectancy since 1990 are shown to the right of the solid line. The causes that have taken away years of life expectancy since 1990 appear to the left of the line. Data are shown for life expectancy at birth.

The screen grab also illustrates how progress against certain diseases has driven up life expectancy in these countries. To see which diseases account for these increases in life expectancy, look to the right of the solid black line that represents life expectancy in 1990 in each row. The causes that have accounted for the biggest increases in life expectancy across the countries are diarrhea, lower respiratory infections, and other common infectious diseases combined.

Despite this impressive progress, much work remains to be done. Diarrhea, lower respiratory infections, and other common infectious diseases remain among the leading causes of death in Central and Eastern sub-Saharan Africa. A new study published in The Lancet in August 2015 shows that investing in interventions that contribute to income growth, increased educational attainment, and access to family planning is important to further reduce early death and disability from the diseases that dominate in many sub-Saharan African countries. The study found that sociodemographic status – which includes per capita income, population age, fertility rates, and years of schooling – explains more than half of the differences in health loss across countries for causes such as diarrhea, lower respiratory infections, other common infectious diseases, maternal and newborn disorders, and nutritional deficiencies.

While there are many countries in sub-Saharan Africa that are highly dependent on donor funding in health, this funding has contributed to increasing in life expectancy. Continued support from donors, especially for interventions that boost income, educational attainment, and coverage of family planning, will be important for continuing the progress that has been achieved over the past two decades.

Katie Leach-Kemon, MPH

Policy Translation Specialist

Institute for Health Metrics and Evaluation | University of Washington